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Study comparing the applicability of dorsal lumbotomy in older children
Jonathan Cloutier1, Nadim Haidar, Marie-Pier Rompre-Deschenes
1Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Université Laval, Quebec, QC.
Insights
Dismembered pyeloplasty via dorsal lumbotomy shows similar success rates in children under and over five years old. This surgical technique is effective and safe for treating ureteropelvic junction obstruction in all pediatric age groups.
Area of Science:
- Pediatric Urology
- Surgical Oncology
- Nephrology
Background:
- Dismembered pyeloplasty using dorsal lumbotomy is a standard procedure for ureteropelvic junction obstruction.
- This technique is often considered more challenging in older children, leading to a perception of lower success rates.
Purpose of the Study:
- To compare the surgical success and long-term outcomes of dismembered pyeloplasty in children younger than 5 years versus those 5 years or older.
- To evaluate the safety and efficacy of dorsal lumbotomy pyeloplasty across different pediatric age groups.
Main Methods:
- Retrospective chart review of 134 children undergoing pyeloplasty.
- Patients were divided into two groups: <5 years (n=90) and ≥5 years (n=44).
- Comparison of patient characteristics, operative time, hospital stay, narcotic use, and success rates, defined by symptom absence and radiographic/scintigraphic improvement.
Main Results:
- Mean follow-up was 26 months.
- Success rates were comparable: 89% in children <5 years and 90% in children ≥5 years.
- While operative time was longer and analgesia requirement higher in older children, hospital stay was similar for both groups.
Conclusions:
- Dismembered pyeloplasty through dorsal lumbotomy demonstrates comparable success rates in both younger and older children.
- The technique is effective and safe for treating ureteropelvic junction obstruction across a wide pediatric age range.
Objective:
: Dismembered pyeloplasty through dorsal lumbotomy to correct ureteropelvic junction obstruction is mainly successfully performed in children under 5 years old for technical reasons. We compared children who underwent dorsal lumbotomy by age group (<5 vs. ≥5 years old) to determine if the surgical success and long-term results were comparable.
Materials And Methods:
: We retrospectively reviewed the charts of 134 children undergoing a pyeloplasty. Group 1 consisted of children <5 years old (n = 90) and Group 2 consisted of children ≥5 years old. Patients' characteristics, as well as hospital stay, narcotic use, radiologic follow-up and success rate, were compared. Success was defined by absence of symptoms and ≥50% reduction in renal pelvis anteroposterior diameter and/or scintigraphic normalization of the drainage T1/2 when obtained. Univariate analysis was performed to compare the groups.
Results:
: Mean age (years) and weight (kg) at surgery for Groups 1 and 2 were 1/8 kg and 11/35 kg, respectively. Mean operative time was 98 minutes versus 120 minutes, respectively; mean hospital stay was 2.5 days for both groups and analgesia requirement was 50% higher in Group 2. A Pippi-Salle stent was used in 90% (n = 120) of cases. Mean follow-up was 26 months and the success rate was 89% and 90% for Groups 1 and 2, respectively.
Conclusion:
: Our study showed comparable success rates. We can infer that, as a technique, dismembered pyeloplasty is effective and safe in the younger and older children.
